Individual
SARAH R MANNIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1509 CEDAR RIDGE DR, O FALLON, IL 62269-4233
(815) 245-4778
Mailing address
1509 CEDAR RIDGE DR, O FALLON, IL 62269-4233
(815) 245-4778
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008833
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/07/2021
Last updated
02/26/2022
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